Curbing Health Care Costs - Methodology

Learning Curve Research

Public opinion generally isn’t static. As people engage on complex issues and weigh trade-offs, their views tend to evolve. We study this evolution through a process we call Learning Curve Research, which uses a variety of methodologies. (We call it Learning Curve Research because it's based on our founder'sLearning Curve theory of public opinion.)

Each participant had at least some recent contact with the health care system as patients. Participants were 40 to 64 years old. We expected that this age group – as patients and potential caretakers of children or elderly parents – would have the broadest perspective on the health care system. This is also a politically significant group that tends to vote at high rates.

Participants were also recruited to represent a broad cross-section of the public in terms of gender, socioeconomic status, race/ethnicity and health insurance status. Focus groups took place in professional focus group facilities and all participants were compensated for their time.

First, participants engaged in three-hour focus groups divided into three main parts:

1. Participants had a general conversation about the health care system, the quality of care they receive and their experiences with costs.

2. Facilitators presented participants with information about the nation’s healthcare costs, including cost and quality comparisons over time, across countries and across different areas in the United States. Participants responded to the information, asked questions and discussed it as a group. This information is available for download here.

3. After a short break, participants deliberated over three approaches to addressing the nation’s health care cost problem using a Choicework discussion guide developed by Public Agenda, which you can read here. The policy approaches were based on a review of reforms and changes to the health care system that leaders and experts have proposed, are experimenting with or have already implemented.

The choices are not meant to be exhaustive or comprehensive, but to provide a basis for deliberation and reflection. The discussion guide laid out a set of concrete practices and policies that could help address the health care cost problem, including the advantages and trade-offs of each approach.

The choices, in brief, were:

Approach A. Give people more responsibility for their health and health care.

Participants discussed measures that were geared toward ensuring that people have more “skin in the game” through taxes on unhealthy lifestyle choices, high-deductible insurance plans and copays, as well as more choice among insurance plans and health care providers.

Approach B. Make sure doctors and hospitals work in smart, cost-effective ways.

Participants discussed the issues surrounding payment reform, including pay-for-performance and charging flat fees per patient or episode of care, as well as incentivizing providers to work in teams, coordinate care and share electronic health records.

Before and after the group sessions, participants completed surveys that assessed their awareness of and opinions about health care costs, their issue knowledge and their sense of efficacy to effectively deliberate with fellow citizens.

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Finally, we conducted follow-up telephone interviews with all participants, within a week after the focus groups. The interviews explored what participants took away from the conversations and how they were thinking about the various approaches to reducing spending after they had the time to “sleep on” the issues and perhaps discuss them with others.

These interviews also gave participants opportunities to reflect on the deliberative research process and to express views they may not have shared in the groups.

The deliberative focus groups were conducted in Secaucus, New Jersey; Montgomery, Alabama; and Cincinnati, Ohio. A pilot was conducted in Stamford, Connecticut, allowing us to test the Choicework guide, graphs and charts on health care costs, the moderators guide and the surveys.